Osteoid Osteoma - 肌肉骨骼系統- 教育訓練- 放射診斷科

The history and radiologic appearance of this lesion make the diagnosis of osteiod osteoma. Stress fracture may occur at this particular location and may be ... 我要掛號 門診進度 門診時刻表 History:A12y/oboysufferedfrommedialthighpain(left)thatisworseatnightbutwhichisrelievedbyaspirinandnonsteoidalanti-inflammatorydrugs. Questions: Whatarethefindings? Whatisthedifferentialdiagnosis? Whatisthediagnosis? Answers: Planeradiographyofthepelvisandlefthip:Aradiolucentnodulewithreactivesclerosisnearthelessertrochanteroftheleftfemur.CTofthebilateralupperthighswithoutcontrast:Anintracorticalradiolucentnodule(<1cm)withexuberantreactivesclerosisatthenearthelessertrochanteroftheleftfemur. Osteoidosteoma,stressfracture,Brodie'sabscess,osteosarcoma OsteoidOsteoma DiscussionThehistoryandradiologicappearanceofthislesionmakethediagnosisofosteiodosteoma.Stressfracturemayoccuratthisparticularlocationandmaybeevidentascorticalthickening,butthereshouldnotbeafocallesionatthecenterofthecorticalreaction,andpainwouldberelievedatnightbutworsewithactivityduringthedaytime.Osteoidosteomaarerelativelycommonbone-formingtumorthatconsistsofacircumscribednoduleofwovenboneandosteoid(calledthenidus)andasurroundingreactivezoneofthickenedcorticalortrabecularboneandloosefibrovasculartissue.Patientscomplainofapeculiarpainsyndromethatisvirtuallyuniqueamongbonetumors:nocturnalpainthatisrelievedbyaspirinandotherprostaglandininhibitors.Unlikeotherbonetumor,osteoidosteomashaveabundantnervefibers,particularlyinthereactivezone,andthisinnervationappearstocorrelatewiththepainsyndrome.ThereactivezoneresultsinaflareofboneandsofttissueedemaonMRimaging,andthereistypicallyanintensereactiveperiostealresponsethatisdisproportionatetothesmallsizeofthenidus(1cmorless).Treatmentofosteoidosteomaisablation,eitherpercutaneouslyorbysurgery.CostandmorbidityarebothlowerusingCT-guidedpercutaneousablationratherthanopensurgery. Reference1.J.X.O'Connell,S.S.Nanthakumar,G.P.Nielsen,A.E.Rosenberg.Osteoidosteoma:theuniquelyinnervertedbonetumor.ModPathol1998;11:175-80